Anesthesia Coding Alert

Question: We have five physicians and two Certified Registered Nurse Anesthetists (CRNAs) in our practice group. At the present, our physicians believe they are unable to meet all requirements for medical direction--they are performing the preanesthesia and induction, but are not necessarily meeting all the other requirements. This being the situation, we know we cannot bill with the -AA (anesthesia services performed personally by anesthesiologist) or -QX (CRNA service with medical direction by a physician) modifiers. What we appear to have is incomplete medical direction. My question is, should we bill with a -QZ modifier (CRNA service without medical direction by a physician) under the CRNAs name, or is there another modifier that would best meet this situation?

Bonnie Brown
Mountain Home Radiology Consultants, Ark.

Answer: As you know, the Health Care Financing Administration (HCFA) has specific criteria that must be met before a case can be considered medically directed (sometimes referred to as the seven rules of medical direction [listed on page 11]). In the situation you describe, using the -QZ modifier (CRNA service without medical direction by a physician) is probably your best coding option.